Imperial College London

ProfessorHelenWard

Faculty of MedicineSchool of Public Health

Professor of Public Health
 
 
 
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Contact

 

+44 (0)20 7594 3303h.ward Website

 
 
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Location

 

158Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

230 results found

Kim S-H, Gerver SM, Fidler S, Ward Het al., 2014, Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis, AIDS, Vol: 28, Pages: 1945-1956, ISSN: 0269-9370

Objective: Adolescent and young adult (AYA) populations (12–24 years) representover 40% of new HIV infections globally. Adolescence is sometimes characterized byhigh-risk sexual behaviour and a lack of engagement with healthcare services that canaffect adherence to antiretroviral therapy (ART). Despite adherence to ART beingcritical in controlling viral replication, maintaining health and reducing onward viraltransmission, there are limited data on ART adherence amongst AYA globally. Weundertook a systematic review and meta-analysis of published studies reportingadherence to ART for AYA living with HIV.Design and methods: Searches included Embase, Medline and PsychINFO databasesup to 14 August 2013. Eligible studies defined adequate adherence as at least 85% onself-report or undetectable blood plasma virus levels. A random effects meta-analysiswas performed and heterogeneity examined using meta-regression.Results: We identified 50 eligible articles reporting data from 53 countries and 10 725patients. Using a pooled analysis of all eligible studies, 62.3% [95% confidence interval(CI) 57.1–67.6; I2 : 97.2%] of the AYA population were adherent to therapy. The lowestaverage ART adherence was in North America [53% (95% CI 46–59; I2 : 91%)], Europe[62% (95% CI 51–73; I2 : 97%)] and South America [63% (95% CI 47–77; I2 : 85%]and, with higher levels in Africa [84% (95% CI 79–89; I2 : 93%)] and Asia [84% (95% CI77–91; I2 : 0%].Conclusion: Review of published literature from Africa and Asia indicate more than70% of HIV-positive AYA populations receiving ART are adherent to therapy and lowerrates of adherence were shown in Europe and North America at 50–60%. The globaldiscrepancy is probably multifactorial reflecting differences between focused andgeneralised epidemics, access to healthcare and funding.

Journal article

Elmahdi R, Ward H, Cooke G, Fidler Set al., 2014, HIV TESTING Implementation of HIV testing is patchy in the UK, BMJ-BRITISH MEDICAL JOURNAL, Vol: 349, ISSN: 1756-1833

Journal article

Crawford MJ, Sanatinia R, Barrett B, Byford S, Dean M, Green J, Jones R, Leurent B, Sweeting MJ, Touquet R, Greene L, Tyrer P, Ward H, Lingford-Hughes Aet al., 2014, The clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial, Sexually Transmitted Infections, Vol: 91, Pages: 37-43, ISSN: 1472-3263

Objectives To examine the clinical and costeffectivenessof brief advice for excessive alcoholconsumption among people who attend sexual healthclinics.Methods Two-arm, parallel group, assessor blind,pragmatic, randomised controlled trial. 802 people aged19 years or over who attended one of three sexualhealth clinics and were drinking excessively wererandomised to either brief advice or control treatment.Brief advice consisted of feedback on alcohol and health,written information and an offer of an appointment withan Alcohol Health Worker. Control participants receiveda leaflet on health and lifestyle. The primary outcomewas mean weekly alcohol consumption during theprevious 90 days measured 6 months afterrandomisation. The main secondary outcome wasunprotected sex during this period.Results Among the 402 randomised to brief advice,397 (99%) received it. The adjusted mean difference inalcohol consumption at 6 months was −2.33 units perweek (95% CI −4.69 to 0.03, p=0.053) among thosein the active compared to the control arm of the trial.Unprotected sex was reported by 154 (53%) of thosewho received brief advice, and 178 (59%) controls(adjusted OR=0.89, 95% CI 0.63 to 1.25, p=0.496).There were no significant differences in costs betweenstudy groups at 6 months.Conclusions Introduction of universal screening andbrief advice for excessive alcohol use among peopleattending sexual health clinics does not result inclinically important reductions in alcohol consumption orprovide a cost-effective use of resources.

Journal article

Roenn M, Hughes G, White P, Simms I, Ison C, Ward Het al., 2014, Characteristics of LGV repeaters: analysis of LGV surveillance data, SEXUALLY TRANSMITTED INFECTIONS, Vol: 90, Pages: 275-278, ISSN: 1368-4973

Journal article

Macdonald N, Sullivan AK, French P, White JA, Dean G, Smith A, Winter AJ, Alexander S, Ison C, Ward Het al., 2014, Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the UK, SEXUALLY TRANSMITTED INFECTIONS, Vol: 90, Pages: 262-268, ISSN: 1368-4973

Journal article

Mc Grath-Lone L, Marsh K, Hughes G, Ward Het al., 2014, The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics, SEXUALLY TRANSMITTED INFECTIONS, Vol: 90, Pages: 344-350, ISSN: 1368-4973

Journal article

Ward H, Bell G, 2014, Partner notification., Medicine (Abingdon), Vol: 42, Pages: 314-317, ISSN: 1357-3039

Partner notification is an essential part of case management for sexually transmitted infections. Done correctly it reduces persistent or recurrent infection in the index patient, identifies previously undiagnosed infections, and may thus contribute to reduced transmission in the population. The effectiveness of patient referral of partners can be enhanced through the provision of written information and easy access to tests and medication. A recent systematic review of partner notification found that enhanced partner therapy (helping get treatment to partners more rapidly) reduced re-infection in the index case by almost 30% compared with simple patient referral. Provider referral, where the healthcare worker contacts partners directly, can also be effective, and provides an important service for patients who are wary of informing partners themselves. Partner notification services should be available for all patients found to have a sexually transmitted infection, whether the diagnosis is made in specialist settings, or in primary or community-based care. For patients with HIV, partner notification should be addressed when the infection is first diagnosed and revisited for subsequent partners. Access to specialist partner notification services is an important part of any sexual healthcare system. The professional competencies required to undertake partner notification have now been clearly defined.

Journal article

Pallawela SNS, Sullivan AK, Macdonald N, French P, White J, Dean G, Smith A, Winter AJ, Mandalia S, Alexander S, Ison C, Ward Het al., 2014, Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the UK, Sexually Transmitted Infections, Vol: 90, Pages: 269-274, ISSN: 1368-4973

Objective: Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the UK in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model.Design: A prospective multicentre case–control study was conducted at six UK hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV.Methods: Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves.Results: Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%.Conclusions: This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely.

Journal article

Crawford MJ, Sanatinia R, Barrett B, Byford S, Dean M, Green J, Jones R, Leurent B, Lingford-Hughes A, Sweeting M, Touquet R, Tyrer P, Ward Het al., 2014, The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR), HEALTH TECHNOLOGY ASSESSMENT, Vol: 18, Pages: 1-+, ISSN: 1366-5278

Journal article

Rai T, Lambert H, Ward H, 2014, The relationship between migration and HIV risk in north India, Publisher: WILEY-BLACKWELL, Pages: 46-46, ISSN: 1464-2662

Conference paper

Elmahdi R, Cooke G, Fidler S, Ward H, Mackie N, Walsh Jet al., 2014, Continued late diagnosis of HIV in general clinical practice: review of newly diagnosed cases in a large acute London trust (2009-2013), HIV MEDICINE, Vol: 15, Pages: 86-86, ISSN: 1464-2662

Journal article

Elmahdi R, Fidler S, Ward H, Smith Aet al., 2014, SPIT (Saliva Patient Initiated Testing for HIV) Study: Feasibility and acceptability of repeat home-based HIV saliva testing using self-sampling amongst men who have sex with men, HIV MEDICINE, Vol: 15, Pages: 101-101, ISSN: 1464-2662

Journal article

Roenn M, McGrath-Lone L, Davies B, Wilson J, Ward Het al., 2014, The comparative performance of vaginal specimens in detecting chlamydia and gonorrhoea infection: a meta-analytic review

Poster

McGrath-Lone L, Hughes G, Marsh K, Ward Het al., 2014, How accurate are data on sex worker status in genitourinary clinics in England? Results of a cross-sectional survey on the identification and coding of sex worker attendances, Publisher: WILEY-BLACKWELL, Pages: 84-85, ISSN: 1464-2662

Conference paper

Bone A, Mc Grath-Lone L, Day S, 2014, BMJ Open 2014; 4:e004567., BMJ OPEN, Vol: 4, ISSN: 2044-6055

Journal article

Mc Grath-Lone L, Marsh K, Hughes G, Ward Het al., 2014, The sexual health of male sex workers in England: analysis of cross-sectional data from genitourinary medicine clinics, SEXUALLY TRANSMITTED INFECTIONS, Vol: 90, Pages: 38-40, ISSN: 1368-4973

Journal article

de Silva S, Dabrera G, Ward H, 2014, The BASHH Public Health Special Interest Group, SEXUALLY TRANSMITTED INFECTIONS, Vol: 90, Pages: 2-2, ISSN: 1368-4973

Journal article

Davies B, Anderson S-J, Turner KME, Ward Het al., 2014, How robust are the natural history parameters used in chlamydia transmission dynamic models? A systematic review, THEORETICAL BIOLOGY AND MEDICAL MODELLING, Vol: 11

Journal article

Aghaizu A, Murphy G, Tosswill J, De Angelis D, Charlett A, Gill ON, Ward H, Lattimore S, Simmons RD, Delpech Vet al., 2014, Recent infection testing algorithm (RITA) applied to new HIV diagnoses in England, Wales and Northern Ireland, 2009 to 2011, EUROSURVEILLANCE, Vol: 19, Pages: 5-11, ISSN: 1560-7917

Journal article

Elmahdi R, Gerver SM, Guillen GG, Fidler S, Cooke G, Ward Het al., 2014, Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines, Sexually Transmitted Infections, Vol: 90, Pages: 119-124, ISSN: 1368-4973

Objectives: To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics.Methods: A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified.Results: Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%).Conclusions: Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines.

Journal article

Ward H, Day S, 2014, Introduction: Containing women: Competing moralities in prostitution, ISBN: 9780710309426

© Kegan Paul, 2004. Prostitution is a significant part of the European landscape: the sex industry is a major employer today, attracting millions of customers. Images of ‘the prostitute’ shape the gender identity of men and women alike in both negative and positive ways: women may have to avoid red lipstick, longing for red shoes, for fear of being branded a whore; men may have to translate their emotions into hard cash through which they seduce. Men who sell sex themselves are often defined by their bodies, their looks, and they are labelled ‘different’. Prostitution promotes a flurry of anxiety about boundaries, around gender, the family, the nation state, Fortress Europe… Since the times of the so-called White Slave Trade, states have implemented policies for controlling prostitution by containing women at home and unpaid as Wives and Mothers who are not allowed an existence independently of men, and containing women as prostitutes in separate zones, brothels or prisons. During the second half of the 20 th century, women in Europe broke many of these constraints, making use of economic and social opportunities to join the workforce, live and travel independently. Prostitution appeared less central to the definition of women. Yet, contemporary alarm at the massive influx of women into Europe, called Trafficking, has once more prompted new, often contradictory, policies from states seeking both to defend the nation and restrict the space of prostitution as far as possible. As in the 19 th century, prostitution is still the Enlightenment in nightmare form - a caricature of universalism, a network of global intercourse, of interchangeable private female parts loosed from the domestic into the public sphere, transforming the particular (my wife, your daughter) into a public woman accessible to all men.

Book

Althaus CL, Turner KME, Mercer CH, Auguste P, Roberts TE, Bell G, Herzog SA, Cassell JA, Edmunds WJ, White PJ, Ward H, Low Net al., 2014, Scientific summary, HEALTH TECHNOLOGY ASSESSMENT, Vol: 18, Pages: XIX-+, ISSN: 1366-5278

Journal article

Rönn M, Hughes G, Simms I, Ison C, Alexander S, White PJ, Ward Het al., 2014, Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK, Journal of AIDS & Clinical Research, Vol: 5:329

Journal article

Low N, Redmond S, Uusküla A, van Bergen J, Ward H, Andersen B, Götz Het al., 2013, Screening for genital chlamydia infection, Cochrane Database of Systematic Reviews, Vol: 2013

© 2013 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects and safety of chlamydia screening in pregnant and non-pregnant women and in men, compared with standard care, on chlamydia transmission and on complications of infection.

Journal article

Roenn M, Hughes G, Simms I, Ison C, Alexander S, White P, Ward Het al., 2013, Challenges presented by re-emerging sexually transmitted infections: an observational study of lymphogranuloma venereum in the UK, National Conference on Public Health Science - Dedicated to New Research in Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 86-86, ISSN: 0140-6736

Conference paper

Hughes G, Alexander S, Simms I, Conti S, Ward H, Powers C, Ison Cet al., 2013, Lymphogranuloma venereum diagnoses among men who have sex with men in the UK: interpreting a cross-sectional study using an epidemic phase-specific framework, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: 542-547, ISSN: 1368-4973

Journal article

Redmond S, Woodhall S, van Bergen J, Ward H, Uuskuela A, Herrmann B, Andersen B, Gotz H, Sfetcu O, Low Net al., 2013, ESTIMATING THE POPULATION PREVALENCE OF CHLAMYDIA IN EUROPE: SYSTEMATIC REVIEW AND META-ANALYSIS, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: A152-A152, ISSN: 1368-4973

Journal article

Lone LMG, Marsh K, Hughes G, Ward Het al., 2013, THE SEXUAL HEALTH OF MALE AND FEMALE SEX WORKERS ATTENDING GENITOURINARY MEDICINE CLINICS IN ENGLAND, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: A201-A202, ISSN: 1368-4973

Journal article

Rai T, Lambert HS, Piot P, Agarwal KS, Ward Het al., 2013, THE CHANGING RELATIONSHIP BETWEEN MIGRATION AND HIV OVER THE LIFE COURSE OF AFFECTED HOUSEHOLDS IN NORTH INDIA, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: A38-A39, ISSN: 1368-4973

Journal article

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